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The impact of frailty and cognitive impairment on quality of life: employment and social context matter

  • Judith Godin (a1), Joshua J. Armstrong (a2), Lindsay Wallace (a1), Kenneth Rockwood (a1) and Melissa K. Andrew (a1)...



How cognitive impairment and frailty combine to impact on older adults’ Quality of Life (QoL) is little studied, but their inter-relationships are important given how often they co-occur. We sought to examine how frailty and cognitive impairment, as well as changes in frailty and cognition, are associated with QoL and how these relationships differ based on employment status and social circumstances.


Using the Survey of Health, Ageing, and Retirement in Europe data, we employed moderated regression, followed by simple slopes analysis, to examine how the relationships between levels of health (i.e., of frailty and cognition) and QoL varied as a function of sex, age, education, social vulnerability, and employment status. We used the same analysis to test whether the relationships between changes in health (over two years) and QoL varied based on these same moderators.


Worse frailty (b = −1.61, p < .001) and cognitive impairment (b = −0.08, p < .05) were each associated with lower QoL. Increase in frailty (b = −2.17, p < .001) and cognitive impairment (b = −0.25, p < .001) were associated with lower QoL. The strength of these relationships varied depending on interactions with age, sex, education, social vulnerability, and employment status. Higher social vulnerability was consistently associated with lower QoL in analyses examining both static health (b = −3.16, p < .001) and change in health (b = −0.66, p < .001).


Many predictors of QoL are modifiable, providing potential targets to improve older adults’ QoL. Even so, the relationships between health, cognition, and social circumstances that shape QoL in older adults are complex, highlighting the importance for individualized interventions.


Corresponding author

Correspondence should be addressed to: Melissa K. Andrew, c/o Division of Geriatric Medicine, Veterans’ Memorial Building, 5955 Veterans’ Memorial Lane, Halifax, NS B3H 2E1, Canada. Phone: (902) 473-4995; Fax: (902) 473-7133. Email:


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Ackerman, N. and Paolucci, B. (1983). Objective and subjective income adequacy: their relationship to perceived life quality studies. Social Indicators Research, 12, 2548. doi: 10.1007/BF00428859.
Aiken, L. S. and West, S. G. (1991). Multiple Regression: Testing and Interpreting Interactions. Newbury Park, CA: Sage Publications.
Allerhand, M., Gale, C. R. and Deary, I. J. (2014). The dynamic relationship between cognitive function and positive well-being in older people: a prospective study using the English Longitudinal Study of Aging. Psychology and Aging, 29, 306318. doi: 10.1037/a0036551.
Andrew, M. K., Mitnitski, A. B. and Rockwood, K. (2008). Social vulnerability, frailty and mortality in elderly people. PloS one, 3, e2232. doi: 10.1371/journal.pone.0002232.
Barcaccia, B., Esposito, G., Matarese, M., Bertolaso, M., Elvira, M. and De Marinis, M. G. (2013). Defining quality of life: a wild-goose chase? Europe’s Journal of Psychology, 9, 185203. doi: 10.5964/ejop.v9i1.484.
Beydoun, M. A., Beydoun, H. A., Gamaldo, A. A., Teel, A., Zonderman, A. B. and Wang, Y. (2014). Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health, 14, 643. doi: 10.1186/1471-2458-14-643.
Bielderman, A., de Greef, M. H. G., Krijnen, W. P. and van der Schans, C. P. (2015). Relationship between socioeconomic status and quality of life in older adults: a path analysis. Quality of Life Research, 24, 16971705. doi: 10.1007/s11136-014-0898-y.
Blodgett, J., Theou, O., Kirkland, S., Andreou, P. and Rockwood, K. (2014). The association between sedentary behaviour, moderate-vigorous physical activity and frailty in NHANES cohorts. Maturitas, 80, 187191. doi: 10.1016/j.maturitas.2014.11.010.
Börsch-Supan, A. et al. (2013). Data resource profile: the survey of health, ageing and retirement in Europe (SHARE). International Journal of Epidemiology, 42, 9921001. doi: 10.1093/ije/dyt088.
Durá-Ferrandis, E. et al. (2017). Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance). Psycho-Oncology, 26, 18. doi: 10.1002/pon.4404.
Finney, N. and Marshall, A. (2018). Is migration in later life good for wellbeing? A longitudinal study of ageing and selectivity of internal migration. Area, 19. doi: 10.1111/area.12428.
Godin, J., Armstrong, J. J., Rockwood, K. and Andrew, M. K. (2017). Dynamics of frailty and cognition after age 50: why it matters that cognitive decline is mostly seen in old age. Journal of Alzheimers Disease, 58, 231242. doi: 10.3233/JAD-161280.
Hill, N. L. et al. (2017). Subjective cognitive impairment and quality of life: a systematic review. International Psychogeriatrics, 29, 113. doi: 10.1017/S1041610217001636.
Howel, D. (2012). Interpreting and evaluating the CASP-19 quality of life measure in older people. Age and Ageing, 41, 612617. doi: 10.1093/ageing/afs023.
Hyde, M., Wiggins, R. D., Higgs, P. and Blane, D. B. (2003). A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model (CASP-19). Aging & Mental Health, 7, 186194. doi: 10.1080/1360786031000101157.
Kalousova, L. and de Leon, C. M. (2015). Increase in frailty of older workers and retirees predicted by negative psychosocial working conditions on the job. Social Science and Medicine, 124, 275283. doi: 10.1016/j.socscimed.2014.11.055.
Kojima, G. et al. (2016). Frailty predicts trajectories of quality of life over time among British community-dwelling older people. Quality of Life Research, 25, 17431750. doi: 10.1007/s11136-015-1213-2.
Langlois, F., Vu, T. T. M., Kergoat, M. J., Chassé, K., Dupuis, G. and Bherer, L. (2012). The multiple dimensions of frailty: physical capacity, cognition, and quality of life. International Psychogeriatrics, 24, 14291436. doi: 10.1017/S1041610212000634.
Lenardt, M., Kolb, N., Binotto, M., Willig, M. H., Lourenço, T. M. and Albino, J. (2016). Frailty and quality of life in elderly primary health care users. Revista Brasileira de Enfermagem, 69, 478483. doi: 10.1590/0034-7167.2016690309i.
Lumley, T. (2004). Analysis of complex survey samples. Journal of Statistical Software, 9, 119. doi: 10.18637/jss.v009.i08.
Marshall, A. and Nazroo, J. (2016). Trajectories in the prevalence of self-reported illness around retirement. Journal of Population Ageing, 9, 1148. doi: 10.1007/s12062-015-9130-2.
Marshall, A., Nazroo, J., Tampubolon, G. and Vanhoutte, B. (2015). Cohort differences in the levels and trajectories of frailty among older people in England. Journal of Epidemiology and Community Health, 69, 316321. doi: 10.1136/jech-2014-204655.
Mitnitski, A. B., Mogilner, A. J. and Rockwood, K. (2001). Accumulation of deficits as a proxy measure of aging. TheScientificWorldJournal, 1, 323336. doi: 10.1100/tsw.2001.58.
Netuveli, G., Wiggins, R. D., Hildon, Z., Montgomery, S. M. and Blane, D. (2006). Quality of life at older ages: evidence from the English longitudinal study of aging (wave 1). Journal of Epidemiology and Community Health, 60, 357363. doi: 10.1136/jech.2005.040071.
Platts, L. G., Webb, E., Zins, M., Goldberg, M. and Netuveli, G. (2015). Mid-life occupational grade and quality of life following retirement: a 16-year follow-up of the French GAZEL study. Aging & Mental Health, 19, 634–46. doi: 10.1080/13607863.2014.955458.
Puts, M. T. E. et al. (2017). Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. Age and Ageing, 46, 383392. doi: 10.1093/ageing/afw247.
Raggi, A. et al. (2016). Determinants of quality of life in ageing populations: results from a cross-sectional study in Finland, Poland and Spain. PLoS ONE, 11, 117. doi: 10.1371/journal.pone.0159293.
Rockwood, K. and Song, X. (2011). Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey. Canadian Medical Association Journal, 2007, 487495. doi: 10.1503/cmaj.110626.Abstract.
Searle, S. D., Mitnitski, A. B., Gahbauer, E. A., Gill, T. M. and Rockwood, K. (2008). A standard procedure for creating a fraily index. BMC Geriatrics, 8, 24. doi: 10.1186/1471-2318-8-24.
Sterniczuk, R., Theou, O., Rusak, B. and Rockwood, K. (2015). Cognition test performance in relation to health and function in 12 European countries: the SHARE study. Canadian Geriatrics Journal, 18, 144151. doi: 10.5770/cgj.18.154.
Then, F. S. et al. (2014). Systematic review of the effect of the psychosocial working environment on cognition and dementia. Occupational and Environmental Medicine, 71, 358365. doi: 10.1136/oemed-2013-101760.
Theou, O., Brothers, T. D., Rockwood, M. R., Haardt, D., Mitnitski, A. B. and Rockwood, K. (2013). Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans. Age and Ageing, 42, 614619. doi: 10.1093/ageing/aft010.
United Nations Educational, Scientific and Cultural Organization: International Standard Classification of Education (1997).
Wallace, L. M. K., Theou, O., Pena, F., Rockwood, K. and Andrew, M. K. (2015). Social vulnerability as a predictor of mortality and disability: cross-country differences in the survey of health, aging, and retirement in Europe (SHARE). Aging Clinical and Experimental Research, 27, 365372. doi: 10.1007/s40520-014-0271-6.
Wiggins, R. D., Netuveli, G., Hyde, M., Higgs, P. and Blane, D. (2007). The evaluation of a self-enumerated scale of quality of life (CASP-19) in the context of research on ageing: a combination of exploratory and confirmatory approaches. Social Indicators Research, 89, 6177. doi: 10.1007/s11205-007-9220-5.
Zlatar, Z. Z., Moore, R. C., Palmer, B. W., Thompson, W. K. and Jeste, D. V. (2014). Cognitive complaints correlate with depression rather than concurrent objective cognitive impairment in the successful aging evaluation baseline sample. Journal of Geriatric Psychiatry and Neurology, 27, 181187. doi: 10.1177/0891988714524628.


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The impact of frailty and cognitive impairment on quality of life: employment and social context matter

  • Judith Godin (a1), Joshua J. Armstrong (a2), Lindsay Wallace (a1), Kenneth Rockwood (a1) and Melissa K. Andrew (a1)...


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